Сосуд-опосредованные модификации хирургического лечения доброкачественной гиперплазии предстательной железы.

Abstract

Introduction. Benign prostatic hyperplasia (BPH) still stays one of the most common diseases in the male population. Aim of research. To compare efficacy of 3 surgical treatments (laparoscopic retropubic simple prostatectomy combined with provisional clamping of internal iliac arteries and urethrocystoanastomosis [LRP+CIIA+UCA], open [ОAE] and laparoscopic [LAE] Millins’s simple prostatectomy) of benign prostatic hyperplasia (BPH). Materials and methods. 48 patients who underwent surgical treatment of benign prostatic hyperplasia in theNational Research Centre of Endocrinology of the Russian Ministry of Health have been observed during period since 2021 until 2022; 16 patients have been underwent LRP+CIIA+UCA, 16 – ОAE, 16 – LAE. Pre-operative observation included such parameters as body mass index, PSA level, prostatic volume, IPSS score, quality of life (QoL) score, maximal urinary flow rate (Qmax), volume of residual urine, erectile function score (IIEF-5). Operation longevity, catheterization and hospitalization period time, complications rate (Clavien-Dindo I, II, III degree) and blood loss have been evaluated during operative and early postoperative period. Efficacy of surgical treatment of BPH has been found as summary of all included parameters. Results. Despite relatively long period of operation, providing of LRP+CIIA+UCA managed to decrease blood loss (p<0,046), catheterization (p=0,001) and hospitalization (p=0,001) period, complications rate (Clavien-Dindo I, II, III degree). LRP+CIIA+UCA triggers to more expressed symptomatic regression (LRP+CIIA+UCA=15 [93,75%]; ОAE=13[81,25%]; LAE=11[68,75%], p=0,001) and clinical remission (LRP+CIIA+UCA=14 [87,5%]; ОAE=11 [68,75%]; LAE=10 [62,5%], p<0,001) after 6 months against to ОAE and LAE. Conclusions. Laparoscopic retropubic simple prostatectomy combined with provisional clamping of internal iliac arteries and urethrocystoanastomosis has shown to be more effective than open (ОAE) and laparoscopic (LAE) Millin’s simple prostatectomy due to decreased blood loss, shortened catheterization and hospitalization period, prevention of lower urinary tract cicatricial deformity.